Treatment regimens

For adults with chronic hepatitis B who require treatment, use:

For information on monitoring antiviral therapy, see here. For information about duration of therapy, see Duration of treatment and stopping therapy.

Tenofovir disoproxil is available as fumarate (300 mg), maleate (300 mg) and phosphate (291 mg) salts; these all contain tenofovir disoproxil 245 mg and are considered bioequivalent.

Tenofovir is the preferred drug for females of childbearing potential who may become pregnant during treatment (if pregnancy is planned or effective contraception is not being used), because it is not associated with an increased risk for mothers or infants. Entecavir is not recommended in pregnancy because there are limited safety data. For more information, see Hepatitis B and pregnancy.

For adults with kidney impairment at baseline, entecavir is usually preferred because tenofovir disoproxil is potentially more nephrotoxic. Both entecavir and tenofovir disoproxil require dose reduction in kidney impairment—seek expert advice.

For patients with HIV co-infection, see Hepatitis B and HIV co-infection.

Peginterferon may be used instead of entecavir or tenofovir in selected adults with chronic hepatitis B who are not cirrhotic. Peginterferon is used more commonly in patients in the immune clearance (HBeAg positive chronic hepatitis) phase than those in the immune escape (HBeAg negative chronic hepatitis) phase. Peginterferon should only be used when recommended by a specialist with expertise in the management of viral hepatitis. The recommended dose is:

If peginterferon is not effective, entecavir or tenofovir can be used—seek expert advice.

Counsel patients about the importance of adherence to treatment, and explain that stopping therapy for any reason can result in a significant hepatitis flare, particularly in the presence of cirrhosis. Patients should not stop therapy unless advised to do so by their specialist.